A Geographical and Historical Survey of the Composition of Urinary Stones

Abstract

The problem of urolithiasis is not a simple one for many kinds of stones are known which probably require different conditions for their nucleation and growth. Calculi are found in the kidneys, ureters, bladder and urethra and for those not resulting from any anatomical abnormality, there is no proven reason why growth should occur in say the upper urinary tract as opposed to the lower. Nevertheless, the results of many epidemiological studies (see, for example, references in review articles such as Andersen, 1969) have shown the existence of well-defined zones in the world in which either upper or lower urinary tract stones predominate. Bladder stones in children and adults are a problem in certain areas of technically developing countries like India and Thailand, while kidney stones in adults constitute most of the calculi from industrialised countries. Some possibly indirect connection between these 2 broad categories is, however, likely, for in certain countries of intermediate economic development, both varieties are found, usually but not always in different areas, and the distribution of upper and lower urinary tract stones in them is again dependent on the extent and duration of "industrialisation" present. There is also evidence that bladder stones were a problem in parts of Great Britain, Northern Ireland and Northern Europe prior to this century but they died out about 50 to 60 years ago and have been succeeded by kidney stones. Conditions which have led or are leading to the disappearance of one kind probably then favour the formation of the other.Stones also differ widely in composition. Many compounds can crystallise in them and frequently several are present in one calculus, but the importance of each constituent, as judged by its frequency of occurrence in collections of stones, varies considerably. In a geographical and historical investigation of the composition of urinary calculi, we have studied representative collections of stones from different countries and found that a few constituents, not always the same, predominate in each but that there is an overall similarity in the total amount of some of the constituents in collections comparable with respect to the variables already mentioned, namely the patient's age, the site of the stone in the urinary tract and the extent of economic development in the geographical area concerned (Sutor, 1972).We have now extended this work using a computer to group together comparable collections of stones and then to derive data on the patients and the calculi in each subdivision. This we hope will lead to a better understanding of the different types of urolithiasis as revealed by our study of stone composition, and demonstrate their distribution past and present on a geographical basis. Material and MethodsCollections of urinary calculi from the following countries, cities and institutions are included in this study: Czechoslovakia (99 stones), Eire (69) England (656 stones from 10 cities), India (176 stones from 2 centres), Kuwait (67) Northern Ireland (...

Mineral Composition of Renal Stones from the Sudan

“…Calcium oxalate stones were found to be the most frequent stones in the Sudan, as is known for other countries [4]. Therefore, our findings are in agreement with the observations of Sutor and coworkers that upper urinary tract stones in adults have the same composition in developing and in industrialized countries [5,6]. In contrast to the composition of pediatric stones in Europe, however, a lower but still considerable number of calcium oxalate stones was found in Sudanese children (60 vs. 43.7%).…”

“…Stones were analyzed in children who came from rural areas, where a low supply of milk and meat products is common. The high amount of NH 4 -urate stones in childhood found by us is in agreement with previous observations by Sutor et al [6], show-Urol Int 1998;61: [154][155][156] Balla/Salah/Khattab/Kambal/Bongartz/ Hoppe/Hesse [4] showed that Ca-phosphate (carbonate apatite) and struvite stones occurred more often in women and children than in male patients with urolithiasis. This might be due to the higher incidence or urinary tract infections in females and children.…”

East Anglian Bladder Stone

“…While in London he was the second 'real founder' with his friend Alexander Marcet of the Medical and Chirurgical Society of London, was its first joint secretary and was chiefly responsible for founding the Society's library (Moore & Paget 1905). The most recent analysis of the composition of the Norwich stones has been that carried out by the late Dame Kathleen Lonsdale and her colleagues, using crystallographic methods, at University College, London (Lonsdale et al 1968) that was part of her group's study of urinary tract stones from various sources (Sutor et al 1974 (Shepherd 1965 …”

Composition of Urinary Tract Calculi from Some Developing Countries

“…These stones occur most frequently in boys in the first decade of life and they are composed mainly of calcium oxalate, or ammonium acid urate (3,4). The stones appear to be caused by malnutrition and they disappear as living standards improve, though the precise nature of the dietary defect, or defects, remains a matter of speculation (5 -7 ).…”